A new study shows the scale of the global obesity crisis.

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There are 1.35 billion people living in China, another 1.23 billion living in India. The world’s two most populous nations are each home to a crush of humanity that’s almost impossible to comprehend. But those numbers pale next to the overweight people who live in the world today—2.1 billion, or nearly a third of the world’s population.

The numbers come from a study published yesterday in the journal The Lancet. Researchers looked at 1,700 studies from 188 countries conducted between 1988 and 2013 in order to come up with a comprehensive view of what’s a truly global obesity epidemic.

However, it wasn’t North America—where Mexico and the United States have vied for the title of the fattest nation in the world—that registered the highest obesity rate. Rather, the Middle East and North Africa are the worst; nearly 60 percent of men and 65 percent of women are too heavy. The study says the U.S. is home to 13 percent of the world’s overweight population, the highest percentage of any country.

The sky-high rates in North Africa and the Middle East may come as a shock in the West, where public health stories from the Arab-speaking world can’t break through the wall of coverage of American invasions, oil, revolution, civil war, and military coups. If anything, most of the region borders the Mediterranean, which is most famous in dieting circles as a way to eat a healthy diet heavy in plants, seafood, and the occasional glass of red wine. Even if there’s less wine consumed with dinner in these predominately Muslim countries, they still consume a whole lot of olive oil. But the red flags have been flying for decades, however, and a combination of urbanization, globalization, and regional cultural norms has created a massive public health crisis.

In 2001, a study published in The Journal of Nutrition looked at the obesity rates in Morocco and Tunisia and found that while their governments were still working to address issues of malnutrition and micronutrient deficiencies, the waistlines of women in both countries were expanding at an unhealthy rate. Public health officials were doing little at the time to address the problem, according to the researchers, “especially since female fatness is viewed as a sign of social status and is a cultural symbol of beauty, fertility and prosperity.” With more people living in urban areas, where processed foods were cheap and easily accessible, issues like malnutrition were steadily being alleviated. But the study goes on to say that, “Western culinary influences lead to new consumption patterns, which affect dietary habits and even the rhythm of consumption.” The study continues, “These new dietary habits have created conditions for chronic diseases like obesity and diabetes to take hold.”

Elsewhere in the region, especially in oil-rich countries, diet trends have followed a similar course. In Saudi Arabia, meat consumption increased by 500 percent between 1973 and 1980, according to a 2011 article in The Journal of Obesity. Changes weren’t as dramatic in less wealthy nations, but the same paper notes that people in Jordan nearly doubled how much meat they ate over the same period, and that the percentage of calories consumed as fat by children in Lebanon increased from 24 percent to 34 percent between 1963 and 1998.

Wealth and development can change diet and health by increasing the amount of meat used in regional cuisines—but American-style dining also seems to crop up in emerging markets around the world, and the Middle East in no exception. Just as global fashion brands and, more recently (and disastrously), institutions like New York University, have tried to catch some of the shimmer of the Gulf’s oil wealth, so have fast-food companies.

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“Demand for fast casual dining, which includes the more traditional fast-food chains such as McDonald’s as well as the table service brands like IHOP, is growing amid a rise in disposable income, extravagant shopping malls, and a seemingly unquenchable appetite for Western food concepts,” reads a 2012 trend story on the website Arabian Business. The article cites a study from the research firm Euromonitor that predicts the fast-casual dining in the United Arab Emirates will expand from $6.4 billion in 2011 to $8.7 billion in 2015. Burger chains are expected to propel the boom.

And just as meat consumption has increased across the region, so has the saturation of fast-food brands. The trade website Food Business Africa points out that the demographics across the Middle East and North Africa present an ideal market for fast-food companies: Huge populations of young people who have “grown up eating processed foods and dining in Western-style fast-food restaurants and coffee shops.” For the youth in this region—and around the world, for that matter—drive-through hamburgers are as much of a birthright as for kids in the U.S.

American-style fast food is no longer a foreign novelty, and neither is American-style obesity.